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Randomized Pragmatic Trial of Stroke Transitional Care: The COMPASS Study.

Publication ,  Journal Article
Duncan, PW; Bushnell, CD; Jones, SB; Psioda, MA; Gesell, SB; D'Agostino, RB; Sissine, ME; Coleman, SW; Johnson, AM; Barton-Percival, BF ...
Published in: Circ Cardiovasc Qual Outcomes
June 2020

Background The objectives of this study were to develop and test in real-world clinical practice the effectiveness of a comprehensive postacute stroke transitional care (TC) management program. Methods and Results The COMPASS study (Comprehensive Post-Acute Stroke Services) was a pragmatic cluster-randomized trial where the hospital was the unit of randomization. The intervention (COMPASS-TC) was initiated at 20 hospitals, and 20 hospitals provided their usual care. Hospital staff enrolled 6024 adult stroke and transient ischemic attack patients discharged home between 2016 and 2018. COMPASS-TC was patient-centered and assessed social and functional determinates of health to inform individualized care plans. Ninety-day outcomes were evaluated by blinded telephone interviewers. The primary outcome was functional status (Stroke Impact Scale-16); secondary outcomes were mortality, disability, medication adherence, depression, cognition, self-rated health, fatigue, care satisfaction, home blood pressure monitoring, and falls. The primary analysis was intention to treat. Of intervention hospitals, 58% had uninterrupted intervention delivery. Thirty-five percent of patients at intervention hospitals attended a COMPASS clinic visit. The primary outcome was measured for 59% of patients and was not significantly influenced by the intervention. Mean Stroke Impact Scale-16 (±SD) was 80.6±21.1 in TC versus 79.9±21.4 in usual care. Home blood pressure monitoring was self-reported by 72% of intervention patients versus 64% of usual care patients (adjusted odds ratio, 1.43 [95% CI, 1.21-1.70]). No other secondary outcomes differed. Conclusions Although designed according to the best available evidence with input from various stakeholders and consistent with Centers for Medicare and Medicaid Services TC policies, the COMPASS model of TC was not consistently incorporated into real-world health care. We found no significant effect of the intervention on functional status at 90 days post-discharge. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02588664.

Duke Scholars

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

June 2020

Volume

13

Issue

6

Start / End Page

e006285

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transitional Care
  • Time Factors
  • Stroke
  • Program Evaluation
  • Patient-Centered Care
  • Patient Reported Outcome Measures
  • Middle Aged
  • Male
 

Citation

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Duncan, P. W., Bushnell, C. D., Jones, S. B., Psioda, M. A., Gesell, S. B., D’Agostino, R. B., … COMPASS Site Investigators and Teams., . (2020). Randomized Pragmatic Trial of Stroke Transitional Care: The COMPASS Study. Circ Cardiovasc Qual Outcomes, 13(6), e006285. https://doi.org/10.1161/CIRCOUTCOMES.119.006285
Duncan, Pamela W., Cheryl D. Bushnell, Sara B. Jones, Matthew A. Psioda, Sabina B. Gesell, Ralph B. D’Agostino, Mysha E. Sissine, et al. “Randomized Pragmatic Trial of Stroke Transitional Care: The COMPASS Study.Circ Cardiovasc Qual Outcomes 13, no. 6 (June 2020): e006285. https://doi.org/10.1161/CIRCOUTCOMES.119.006285.
Duncan PW, Bushnell CD, Jones SB, Psioda MA, Gesell SB, D’Agostino RB, et al. Randomized Pragmatic Trial of Stroke Transitional Care: The COMPASS Study. Circ Cardiovasc Qual Outcomes. 2020 Jun;13(6):e006285.
Duncan, Pamela W., et al. “Randomized Pragmatic Trial of Stroke Transitional Care: The COMPASS Study.Circ Cardiovasc Qual Outcomes, vol. 13, no. 6, June 2020, p. e006285. Pubmed, doi:10.1161/CIRCOUTCOMES.119.006285.
Duncan PW, Bushnell CD, Jones SB, Psioda MA, Gesell SB, D’Agostino RB, Sissine ME, Coleman SW, Johnson AM, Barton-Percival BF, Prvu-Bettger J, Calhoun AG, Cummings DM, Freburger JK, Halladay JR, Kucharska-Newton AM, Lundy-Lamm G, Lutz BJ, Mettam LH, Pastva AM, Xenakis JG, Ambrosius WT, Radman MD, Vetter B, Rosamond WD, COMPASS Site Investigators and Teams. Randomized Pragmatic Trial of Stroke Transitional Care: The COMPASS Study. Circ Cardiovasc Qual Outcomes. 2020 Jun;13(6):e006285.

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

June 2020

Volume

13

Issue

6

Start / End Page

e006285

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transitional Care
  • Time Factors
  • Stroke
  • Program Evaluation
  • Patient-Centered Care
  • Patient Reported Outcome Measures
  • Middle Aged
  • Male